I have learned a copious amount of knowledge during this incredible experience at the University of the Free State.  My eyes were greatly opened to the world of dietetics and nutrition on an educational standpoint.  But what I cherish more is what cannot be taught within the walls of a classroom; the wisdom I obtained from working in the townships and communicating with people from different backgrounds and cultures.  All of my learning over the past month will resonate within me for years to come and I hope to share with others the knowledge that has been bestowed upon me.  I cannot thank all that have helped me get to where I am and those who have been so supportive throughout my journeys.  A special thanks to Dr. Jones and my parents.


P.S.  I MADE IT TO ROCKLANDS and it was some of the most incredible climbing I have ever seen.  I am planning another trip back as we speak!

Sunset Traverse at The Pass

Tuesday, 19 June 2012

Medi-Clinic (Private Sector)

Summary
 Today was very similar to yesterday, we began with round of the Neonatal ICU, Pediatric ICU, and Pediatric Ward in Medi-Clinic.  We then did patient assessments at a rehabilitation clinic, Care Cure Clinic: Victoria Gardens, and a psychiatric clinic, Optima.  It was a frustrating day personally because of the amount of information I did not learn due to everything being spoken in Afrikaans.

Detailed Account 
Much like yesterday we did rounds through the Neonatal ICU, Pediatric ICU, and Pediatric Ward today.  Luckily I was allowed in the Neonatal ICU today and the babies were minuscule, with hands as small as quarters.  Unfortunately I did little learning from this because Anna-Marie simply made notes about the children and reviewed their feeds.  We then went to the Pediatric areas and the same thing occurred.  I am extremely frustrated by this portion of the internship because I feel like a nuisance.  I simply just stand there doing nothing.  All of the other places I was introduced as an exchange student from America and if English was known by both parties English was spoken.  If English was not known then the dietician would translate conversations and explain what they were doing or the plan of action.  At Medi-Clinic every person there is able to speak English yet no one does and at the end of each ward round I stand awkwardly listening, but not understanding, to a personal conversation between the dietician and a nurse.  Don't get me wrong I think the dietician is so extremely sweet when we are in the car and speaking in English but I am very frustrated by the way this section is run.

We then made our was to the Care Cure Clinic: Victoria Gardens to assess patients at a rehabilitation clinic.  One patient had lost the ability to swallow and we changed out her feeding tube that was inserted into her stomach.  We also checked in with the kitchen staff before going to a psychiatric institution, Optima Clinic.  We did a follow up with a patient who would be discharged soon, giving her an at home diet to follow.  Once again everything was spoken in Afrikaans and I was frustrated but that's life sometimes I suppose.

Monday, 18 June 2012

Medi-Clinic (Private Sector)


Summary
The Medi-Clinic was very comparable to a hospital in the states; clean, organized, nurses working, etc.  We did rounds at the Neonatal ICU, Pediatric ICU, and Pediatric Ward before consulting with new patients.  it was a very different environment compared to the other facilities I have been involved with here in South Africa.


Detailed Account
Today started much differently than I had imagined.  Vandghie is the head dietician in the Medi-Clinic but has recently taken maternity leave because she is about to pop.  Therefore I have been helping Anna Marie, who is taking on Vandghie's cases as well as her own.  This morning we went to Vandghie's house to catch up on work from the following week with another dietician.  We first had breakfast and I fell in love with french toast topped with honey and cheese of all things.  Then they got to business, having an administrative meeting and talked about patients.  Thank goodness Vandghie had the sweetest golden retriever because they talked in Afrikaans the entire time although they all knew English and they all could see I was sitting there attempting to listen to what they were saying.

Anna Marie and I made our way to the Medi-Clinic where we did rounds.  She went to the Neonatal ICU, unfortunately I had to wait outside until she was finished.  We then went to the Pediatric ICU with long term and short term patients.  Anna Marie checked patients records and updated her files but didn't tell me about the patients or what she was doing to help their nutritional status.  I asked a few questions and was interested when they informed me about patients but it was rare. Next was the Pediatric Ward where we assessed a new patient who would more than likely be discharged the following day.  Lastly we did a consultation on a 10 month old baby that was not in the hospital.  Anna Marie will follow up with them in a couple weeks and assess the baby's weight gain, if any.

The Medi-Clinic was an interesting opportunity to see compared to the rest of the internship but so far I would rather be in the community visibly observing the changes I can help to make in people's lives.  

Weekend trip to Claren's coming sometime!

Wednesday, 13 June 2012

Southern Free State: Smithfield

Summary

We travelled to Smithfield to learn about the Stoffel Coetzee Hospital and give a presentation on perishable meats and fruits.  I was supposed to give a presentation about nutrition and HIV but it was cancelled due to the fact that no one showed up for it.  We were extremely fortunate and went on a game drive back in Philippolis.

Detailed Account

The drive to Trompsburg followed by Smithfield was long so a very early morning was required.  We began at the Stoffel Coetzee Hospital, one of the three district hospitals.  I was surprised to see the emptiness of the place, the clinics are packed with people wait yet the hospitals are barren.  People are allowed to walk into the hospital just as the clinic but no one seems to, very interesting. 

We immediately made our way to the kitchen to have a look around.  It was large and open but with only one stove and one oven.  The food manager at this hospital had recently been promoted from being the cleaner.  She had no knowledge in food so it has resulted in a difficult transition for Marli.  We went over what was being made for lunch and reminded the cook how to prepare the food properly.  Marli asked what was going to be for dessert and she replied “chocolate mousse.”  Although mousse had to sit overnight so that was yet another learning experience for the kitchen staff that day.  The more I see what Marli deals with on a daily basis the more I realize how necessary a sense of humor is in her sector.

The hospital kitchen 

We gathered all of the two cooks in the hospital for the day and gave a presentation on perishable meats and fruits.  Lastly we went to the cooler to take a look at their fruits and it was remarkable.  The walk in cooler was practically empty with one lone box sitting on a shelf.  Inside the box was fruit, two-thirds were bruised and unusable.  Hopefully the presentation will help with their future meals and preparation.  I found that the cook did as she was told and the best she could, it seemed that a great deal of problems rooted from the food service manager.

We then made our way to another clinic so I could give my HIV and nutrition talk.  I had prepared a presentation to teach newly diagnosed HIV patients about what to eat and how to prepare the food hygienically correct.  We were told that one person had showed up for the talk but left shortly after and therefore my presentation was cancelled.  I was able to learn a great deal about HIV nonetheless.

We headed back to Trompsburg after a lunch break where I tried another traditional dish, Bobotie.  We had passed signs for a place called Otterskloof in Philippolis, something about a game drive.  We called to see what it was about and informed them that we were poor college students.  They told us to drive out and we could talk with them when we arrived so we did just that.  After a cup of tea they loaded us onto one of the coolest cars ever and we set out for an incredible afternoon.  The reserve was 33,000 acres so the animals roamed freely.  Their main income was hunting, many people from around the world pay thousands to come and hunt their animals (so very sad).  We saw everything from waterbuck to buffalo to white and black rinos to zebra to springbok.  It was such an incredible day of adventure and bonding between Imke, Regardt, the guides, and me.  Luckily I made it back with my teeth still intact, I had a near miss.

Otterskloof Game Drive: White rinos!

We made such good friends with the guides that they took us back to their place to play with their Blue Monkey (my future pet) and calf.  We then received fresh biltong (beef jerky but so much better) before they took us to visit their lions!  The lion is such an incredible animal.  There was a father, Simba (really that was his name), three females, and 7 pups of all ages.  They were so cute interacting although Simba's roar was intimidating and downright scary.  The kindness of these people touched my heart deeply and I hope to be able to repay them their hospitality when they come to the states in the future.  This confirms my love for small towns completely.

Conclusion

Working in the community is difficult and you have to make the best of what you have.  I learned a great amount during this section including communicating with people from different backgrounds, the importance of a sense of humor, what roads in the Southern Free State are really like, and the kindness of people and friends.  Overall we put over 1,400 kilometers on the car in 3 and a half days but I came home with experiences and friends that will last a life time. 

My South African Opa!

Tuesday, 12 June 2012

Southern Free State: Edenburg

Summary

 We began with a Diabetic lecture in Edenburg followed by a few patient consultations.  Marli (the head dietician) proceeded to give a refresher course on malnutrition and the Road to Health Growth Booklets for the sisters at the Nelson Mandela Clinic.  I ended the day with my first traditional braii!

Detailed Account

Chilly is an understatement for the temperature of wooden and concrete houses during the winter in the Southern Free State.  Mornings would involvement getting as put together as possible while still in bed and then immediately making tea or coffee.  Along with being chilly, mornings were also very early since a great deal of time is spent driving to different clinics in the Southern Free State. 

We headed to Trompsburg to fetch Marli at 7:45 a.m. before making our way to Edenburg.  We arrived at the Phekolong Clinic and piled into an office-like room.  We moved the desk and added chairs, which were then filled with six diabetic patients.  Imke explained how the body normally functions as well as the problems faced by diabetics.  She then went through foods that were acceptable and not acceptable for diabetic patients to eat and indulge in.  Much like anywhere in the world some people were receptive and eager to learn while others were stubborn and set in their ways.  Nonetheless I think we made a difference by providing knowledge and hopefully it will help them make better lifestyle choices.

Diabetes Presentation

Before departing from the clinic we did a few nutritional assessments of people from the town, much like I did in the hospital and at the homes in the townships.  We asked what foods they ate and portion sizes.  It seemed that people were proud of their large, unhealthy portion sizes and I truly felt that they did not realize the correlation between portion sizes and their obesity or the problems with being that overweight.  It’s hard for me to see people who are unhealthy and know better but it is a whole other sadness I experience when people are overweight due to a lack of education.

Marli explained how each district has its own supplemental standards.  In her district they had to choose between providing cheaper porridge and reaching more people or providing more nutritious porridge but to less people.  In the long run she chose to feed as many people as possible giving supplements that can be found below.  Underweight children (between ages 1 to 5) are given supplements if they are below the 3^rd percentile.  Children between age 5 and 18 are provided supplements if they have a BMI below the 10^th percentile and adults with a BMI below 18.5 (except any TB patients with a BMI below 22)

Age	Supplement		Amount per month
< 6 months	Pelargon		According to weight
6-8 months	Pelargon		6 tins
9-12 months	Pelargon		4 tins
1-5 years	Philani Yabantwana	Nutri-meil	2 bags	4 tins
5-18 years	Philani		4bags
>18 years	Philani		4 bags

Before leaving the Phekolong Clinic we checked their records concerning seeds, stock control, client registers, and their default lists.  Marli made a list of severely malnourished patients who were given to the home based staff to follow up with them daily in the locations.

We took a quick lunch break and I had my first Vetkoek.  It was a large bread dough thing with meat and cheese inside, interesting but good.  Over lunch Marli told us about the job of the operational manager.  She was employed as a dietician but has taken the responsibilities of the operational manager for the last few months.  Their district is 17 towns/clinics with 3 district hospitals.  They have to order the supplements, do the paperwork, and make sure everyone is doing their jobs.  She is not getting paid extra for this but knows that someone must do it so she has stepped up for the responsibility (did I mention she is 7 months pregnant).  She also thinks that this position will never be filled again because that is the way the government works.

Our next stop was the Nelson Mandela Clinic to give a refresher to the nurses on the "Road to Health” Handbook.  Every parent receives this handbook which they bring each time they visit the clinic in their child’s first 5 years.  There are multiple charts and graphs to fill out and plot to determine the health of the child but many of the sisters (nurses) do not complete these properly and therefore cannot be used to their full benefits.

During the discussion we went over the proper way to take the weight, height/length, mid upper arm circumference and where the immunizations we recorded.  We discussed how to establish if a child was malnourished and what to do as well as important terms the sisters should know (stunted, wasted, underweight, overweight, etc.).  Following we discussed the consequences for children who are underweight and the common malnourishment conditions seen within the clinics (Marasmus, Kwashiorkor, and Marasmus Kwashiorkor).  We began the training and finished the training with the same quiz.  The pre-test portion was sad to see the little knowledge the nurses had on conditions and practices they should be using every day while great improvement was seen with the post test.  It is hard for me to determine if the sisters didn’t know this information previously or if they had and just didn’t care enough to take it seriously and use it on a daily basis.  Often times it seems as the nurses have attitudes and feel they are underpaid for the work they do, yet I usually see them on tea breaks throughout the entirety of the days.  I’m not sure what to think of this situation except the patient’s best interest should always be the most important and often times that does not seem to be the case.

That evening we dropped Marli in Trompsburg before returning to Philippolis.  We decided to have a true South African braai and cooked fresh meat with sandwiches and such, it was wonderful!  Imke and Reggie were becoming like a brother and sister to me and to see them interacting and teasing each other was incredible.  I haven’t been homesick with being so busy here but that sure made me thankful for the wonderful brother I have!

My brother and I!!

Monday 11 June 2012

Southern Free State: Trompsburg & Philippolis

Summary

We began our drive to the Southern Free State early this morning where we met with the dietician to go over the plans for the upcoming week.  We established who would do what presentations and what languages they were to be spoken in before getting settled in at the Bed & Breakfast Guesthouse in Philippolis.

Detailed Account

I was picked up bright and early Monday morning by Imke, a 4^th year dietetics student and her brother, Reggie.  She was unable to drive due to a recent ankle surgery; therefore Reggie was our driver and comedian for the week.  We began the hour and a half drive to Trompsburg and began getting to know each other.  Immediately, we all got along well and had lots in common.  Reggie had just returned from a 4 month stay in America so we had plenty to talk about.

When we arrived in Trompsburg we met with Marli, one of the dieticians in charge of many clinics and hospitals in the Southern Free State.  We first found her at the Trompsburg Clinic where she was meeting with patients much like we had previously done at MUCPP.  She administered supplements and did check-ups on the patients before we headed to her office a few miles away.  In her frigid office we went over the plans for the week and what presentations we would need to prepare.  Tuesday would be a Diabetics talk in Afrikaans and a nurse refresher in English.  Wednesday would be a meat and fruit perishable foods talk in English and an HIV session in English.  We would leave early on Thursday morning due to a follow up appointment for Imke’s ankle. 

We left Trompsburg and headed to Philippolis where we would be staying at Die Groenhuis guest house.  The house was large with 6 beds and all the bells and whistles (excluding heat) and the owner was more than friendly (actually becoming my South African Grandfather by the end of the trip).  One of the nicest things was heated blankets that were provided, oh what a treat and so necessary.  The thing that baffled all of us was the fact that Philippolis was an hour’s drive from Trompsburg where we had to return each day to pick up or drop off Marli.  It seems like it would have been more reasonable for us all to stay in the same town but nonetheless we had a lovely time.  When we did arrive in Philippolis we grabbed a quick bite to eat and I was introduced to a Dagwood sandwich.  I stuck with something a bit more normal but Imke and Reggie explained yet another strange South African meal.

When we were settled in Imke and I began reading up our presentations for the upcoming days.  Obviously, she was going to take care of the Diabetes talk in Afrikaans, Marli requested to do the talk with the nurses because she had done it many times before.  For Wednesday I would assist Imke in the perishable foods talk and the HIV talk would be entirely on my own.  So I began reading as much as I could on HIV and patient’s nutritional needs.

My bed with an electric mattress! 

Each day I was fortunate enough to try lots of new South African food and encountered many South African experiences.  That evening we made South African pancakes aka crepes from scratch.  We had both savoury and sweet pancakes and are delightfully delicious!

crepes!